Football and TBI: The Cautionary Tale of Steelers QB Roethlisberger

Research now shows that pro football players who sustain concussions on the field often suffer the consequences of those injuries much later in life. There is a high rate of Alzheimer’s disease, for example, among those who retired from the game many years, even decades, ago. Their golden years are anything but golden.

But there should be considerable concern in the case of young Pittsburgh Steelers quarterback Ben Roethlisberger, the damage that his brain has undergone – both on and off the field – is already impacting his actions. He has gone from a promising star to a troubled young man now charged with assaulting a 20-year-old woman during his 28th birthday party March 5 at a Georgia nightclub.

Roethlisberger, the youngest quarterback to bring his team to a Super Bowl champion, is now a tragedy waiting to happen.

To its credit, the National Football League is trying to step in and help Roethlisberger. NFL commissioner Roger Goodell, according to press reports, wants to meet with the champ to discuss his problems. http://sports.espn.go.com/nfl/news/story?id=5018837 Our concerns is that unless the NFL puts this evaluation into the context of Roethlisberger’s many brain injuries, the cause of his problems may not be identified.

For a man who isn’t even 30, Roethlisberger has already suffered head injuries not only on the football field, but off-duty, as the result of a dreadful motorcycle accident.

As part of his NFL career, last season Roethlisberger sustained his fourth concussion during his then-5 _ year pro football career. Ironically in December last year, after getting that last concussion, Roethlisberger boasted in an interview that he was fine. “I feel great. I’m ready to go,” Roethlisberger said. “Practiced yesterday, felt good, no headaches, ready to rock and roll.” http://www.thepittsburghchannel.com/sports/21799204/detail.html

Roethlisberger was thrown into the Chrysler’s windshield, and then fell and hit the ground head first, according to a report in the Pittsburgh Post-Gazette.

The quarterback had a 9-inch cut on the back of his head. He broke his jaw. He broke his nose. He chipped some teeth.

At the time Dr. Daniel Pituch, the chief of the division of oral and maxillofacial surgery at Mercy Hospital, told reporters that after facial surgery Roethlisberger was in serious but stable condition. “His brain, spine, chest and abdomen appear to be without serious injury, and there are no other confirmed injuries at this time,” Pituch said.

Roethlisberger reportedly landed head first, yet didn’t have any “serious” brain injury, according to his doctor. Looking back, it may have been more serious than at first thought, or at a minimum made him far more vulnerable to problems from subsequent concussions.

Among them was Sandra Ford, a Homewood writer and artist, who had just finished teaching a writing class at the Allegheny County Jail and was waiting for a bus on the Armstrong Tunnels side of Second Avenue. Attracted by the loud exhaust, she noticed a motorcycle approaching from her right ridden by a rugged-looking white man with curly hair.

“He was sailing, like he was enjoying the ride. He was going at a good clip but wasn’t going overly fast,” Ms. Ford said.

She said as he passed her, she noticed a car turning left in front of him. She said she expected the motorcycle to slow down or even have to slam on the brakes but was blocked from further view by cars traveling inbound. And then she heard a “crunching sound” and saw the motorcyclist fly over the car.

“He was a like a doll someone threw up into the air,” Ms. Ford said. “I ran to the scene and he was lying on his back and wasn’t moving. I thought he was dead.”

The witness said she saw the accident and went over to help but did not recognize Roethlisberger. When she asked him what his name was, she said he replied, “Ben.”

The woman added that Roethlisberger asked her a series of questions, including where he was and what state he was in. He attempted to stand up but the woman said she encouraged him not to move until paramedics arrived.

The most serious injury he suffered in this accident may not have the broken bones, but a brain injury. One of his doctors described it as a “mild concussion.” A mild concussion does not involve either a loss of consciousness or amnesia. There is not a single brain injury professional I know who would not call this a brain injury, even if they were hired by an insurance company. The above statements describe not only disorientation, but probably also amnesia. Not knowing what state he was in is evidence of retrograde amnesia, lack of memory of the events of the day before the accident. Motor vehicle wrecks involve significantly more potential for injury than being hit by a defensive lineman. His head hit the windshield of another car. We have seatbelts in our cars because of the danger of that type of contact, even when sitting inside a confined space.

What isn’t being done is to put this injury into the context of what is happening now: The quarterback stands charged with assaulting a female college student at his birthday party. He denies any wrongdoing. That’s not the only incident where Roethlisberger has been accused of hurting a female. A woman who alleges that the quarterback raped her at a hotel in Lake Tahoe in 2006 is suing him. Roethlisberger denies those allegations.

That bring us back to commissioner Goodell, and his plans to talk to Roethlisberger, presumably about the Atlanta incident.

At the NFL’s meeting in Orlando earlier this month, Goodell said, “We take this issue very seriously. I am concerned that Ben continues to put himself in this position.”

It may be brain damage is contributing to Roethlisberger’s problems. People think of the brain injury as primarily resulting in cognitive deficits, but with most brain injuries, especially those that do not involve coma, the biggest problems are neuro-behavioral. All behavior, emotions and thought are found in the brain. Most of what we think of as maturity is a decade long process of learning social conventions as we go through puberty into adulthood. Most of those behavior controls are stored in the frontal lobes of the brain, often times the lower frontal lobes, immediately above the eye sockets. That also happens to be the area most vulnerable any time the skull is impacted with significant force, regardless of where the exact point of contact is.

We don’t know how serious a brain injury is based just upon the severity of what happened in the moments around the injury, although with Roethlisberger there is truly serious reasons for concerns: loss of consciousness, confusion and amnesia, broken facial bones. We learn of the seriousness of a brain injury by how it impacts the person, how it changes the way the brain works. With anything but the most serious of brain injuries, often those changes are not as obvious as they seem and often they will be more changes in behavior than changes in how someone appears to think. Sexual inhibitions – the “stop button” – are some of the most easily changed behaviors after a brain injury.

Clearly, Roethlisberger functions on a high cognitive level. As I have said repeatedly on my blogs, quarterbacking an NFL team is one of the most cognitively challenging tasks there is.

The Steelers, the NFL, Roethlisberger must reexamine the connection between behavior and judgment that are causes of concern and the series of brain injuries Roethlisberger has suffered. If he were my client, I would want a new round of MRI scans, all done on a 3 Tesla machine, including SWI and Diffusion Tensor Imaging. I would want a thorough neuropsychological evaluation, but one that took his off the field behaviors into account, as well as the raw scores on his evaluations.

The issue here is not whether Goodell suspends Roethlisberger for a few games for putting himself in the wrong kind of situations. The issue is whether Roethlisberger’s brain is now so vulnerable that he should not risk subjecting himself to the invariable risk of further concussions that his day job involves.

Sounds good in theory, but Ben’s reputation and all of the talk in Pittsburgh is that Ben’s conduct now is a continuation of his conduct and reputation before his NFL and motorcycle concussion incidents. I have heard that Ben has an attitude that he is not subject to the rules of society and human interaction, and therefore walks out on restaurant tabs and forces himself on others beyond their consent. Unfortunately, I think Ben is more a “victim” of a society that treats young athletes like they are gods–whether its teachers giving them leeway, booster clubs giving them exorbitant gifts, girls willingly jumping in their laps, and the sheriff looking the other way. Attorney Johnson, proof of causation will require a change of conduct from before his concussions and after them. By no means am I saying that concussions don’t cause brain injuries and resulting symptoms, which can be significant and long term. The references and statements by Attorney Johnson may well be valid—except as applied to Ben Roethlisberger. Good theory; bad example.

Good comment Andy. Proving causation in our cases is always the challenge, especially when certain aspects of behavior that are impacted by brain injury were there before. I of course couldn’t make a decision as to whether I would advocate for a brain injury in this case until I had a full clinical history, access to high quality MRI scans and detailed neurobehavioral analysis and testing. But it is also very possible that Ben’s strengths weren’t in judgment before hand anyway, making it that more likely that brain injury would significantly impair him now. It is the most vulnerable that are disabled by concussion. Ben’s body isn’t vulnerable. His frontal lobes may very well be.

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